"On deformity of the chest in children"

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Lancet
(31 July 1847): 137
Letter submitted during week of 10-16 July, 1847.

PDFs courtesy of Elsevier, via the Health Sciences Center Library, Emory University. Included are Rees' paper and Snow's reply, transcribed below.

Snow's letter to the Editor bears on the following statements by George A. Rees, M.D., made in his paper, "On deformity of the chest in children." Lancet 2 (10 July 1847): 37-38.

"In the report of the proceedings of the Westminster Medical Society, contained in the Lancet of May 1st [1847], mention is made of a paper, read by Mr. Hird, "On Deformity of the Chest in Children, accompanied with altered Movement of the Ribs in Respiration," which is, though, most probably, without the author being aware of it, a transcript, to some extent, of a paper I sent, some years since, (1839) to the Medical Gazette.

It is singular that a paper was read before the Westminster Medical Society in 1841, by Dr. Snow, on the same subject, to which paper he referred at the late meeting, when speaking of Mr. Hird's cases, and which paper contained exact quotations from mine in the Medical Gazette; but without any mention of the source whence the quotations were derived--an omission I complained of at the time. I think Dr. Snow, when referring to Mr. Hird's cases, should have made the amende honorable by stating who really did first point out these cases, and not have been content with the statement, 'that this kind of deformity had been noticed by writers in this country' It is true, priority of remark in so simple an affair is little to boast of, nevertheless, it is well to cultivate in trifles that strict sense of liberality and justice which should be the guide of professional conduct--a want of which I believe has mainly contributed to the present disorganized state of the profession; and it is necessary to remember, that they who have made no great discoveries are the more captious about what they may really call their own.

. . . . . . . . . . . .

Dr. Snow is perfectly correct in stating that these cases are usually combined with more or less abdominal enlargement; but in considering the deformity, the result of such enlargement, he has, in my opinion, mistaken the effect for the cause" (37).

Snow responded as follows:

To the Editor of the Lancet.

Sir,--I feel it my duty to reply to a very grave, though totally unfounded, charge made against me by Dr. G. A. Rees in the last number of the Lancet [actually, three issues previous to this one, which permits us to date the composition of his letter sometime during week of 10-16 July]. He [Rees] says that a paper read by me to the Westminster Medical Society in 1841 contained exact quotations from a paper of his in the Medical Gazette, but without any mention of the source whence the quotations were derived. The very reverse of all this is true. I referred to his paper in the most handsome manner, stating his name, and the date and place of it, but made no quotations from it, as any one may ascertain. My paper was published in the Medical Gazette [vol. 28] of April 9th, 1841. The title of it was, "On Distortions of the Chest and Spine in Children, from Enlargement of the Abdomen" [see p. 115 on Rees]. Dr. Rees' communication was entitled, "On Deformity of the Chest in Young Children, from Disease of the Lungs." How any extract from his paper could have served my purpose it is not easy to conceive. In his former complaint to which he alludes, he did not accuse me of making exact quotations, but chiefly confined himself to endeavouring to show that my cases were of the same nature as his own, and that they did not depend on enlargement of the abdomen. He did, indeed, make an insinuation, for which he ought to have apologized after my reply, which appeared in the following number of the Lancet--that of April 10th, 1841, at page 112. As Dr. Rees has withdrawn his opinion, that the change which he met with in the lungs was the result of inflammation, and as he now admits that there is usually abdominal enlargement, I am inclined to believe that his cases are of the same nature as those which I described. In the case detailed in my paper, the greater part of the lungs was collapsed, and void of air. I offered no explanation then of the cause of this, but I now consider that the deformity in question, after it attains a certain degree, may cause compression of the lungs, and have the same effect on them as a pleuritic effusion would have, and thus terminate life. In my opinion, then, the condition of the lungs, which Dr. Rees considers to be the cause of the deformity, is an occasional consequence of it. When deformity is the result of disease of the lungs, it does not affect both sides of the chest alike.

On the late occasion I alluded again, in the Society, to Dr. Rees' paper, and stated his opinions, previous to mentioning my own paper, although if I had not done so, but had included him amongst authors in this country in the abbreviated language of the report, and had so passed from Dupuytren to my paper in the Society, on which I was speaking, he would have had no ground for complaint. As to my stating who really did first point out these cases, Mr. Hird had already done that in mentioning Dupuytren, whose cases, now that Dr. Rees has just alluded to them for the first time, he tries to show differ from his own, though to me that is not apparent.

The letter I am now answering commences by a statement, that Mr. Hird's paper was a transcript, to some extent, of one by Dr. Rees. I feel assured that Mr. Hird knew nothing of that paper till I alluded to it. Dr. Rees, indeed, says, a transcript, "most probably without the author being aware of it." Now, it so happens that Mr. Hird wrote nothing, and read nothing, but only related a case or two, and made some remarks on them. But supposing that he had really written and read a paper, as he said that he had intended, and that, in some peculiar state of unconsciousness, he had made a "transcript to some extent" of Dr. Rees' paper, how could that gentleman be aware of such transcription, as the supposed paper has not been published, but only, as he says himself, "mentioned?"

I shall be much obliged by the early insertion of this reply; and I remain Sir, your obedient servant,

Frith-street, Soho-square, July, 1847.

John Snow.